Design of the effect of adaptive servo-ventilation on survival and cardiovascular hospital admissions in patients with heart failure and sleep apnoea: the ADVENT-HF trial

Owen D Lyons, John S Floras, Alexander G. Logan, Robert Beanlands, Joaquin Durán Cantolla, Michael Fitzpatrick, John Fleetham, R John Kimoff, Richard S T Leung, Geraldo Lorenzi-Filho, Pierre Mayer, Lisa Mielniczuk, Debra L Morrison, Clodagh M Ryan, Frederic Series, George A Tomlinson, Anna Woo, Michael Arzt, Sairam Parthasarathy, Stefania RedolfiTakatoshi Kasai, Gianfranco Parati, Diego H Delgado, T Douglas Bradley, Maria Teresa La Rovere, Alberto Braghiroli, ADVENT-HF Investigators

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: Both types of sleep-disordered breathing (SDB), obstructive and central sleep apnoea (OSA and CSA, respectively), are common in patients with heart failure and reduced ejection fraction (HFrEF). In such patients, SDB is associated with increased cardiovascular morbidity and mortality but it remains uncertain whether treating SDB by adaptive servo-ventilation (ASV) in such patients reduces morbidity and mortality.

AIM: ADVENT-HF is designed to assess the effects of treating SDB with ASV on morbidity and mortality in patients with HFrEF.

METHODS: ADVENT-HF is a multicentre, multinational, randomized, parallel-group, open-label trial with blinded assessment of endpoints of standard medical therapy for HFrEF alone vs. with the addition of ASV in patients with HFrEF and SDB. Patients with a history of HFrEF undergo echocardiography and polysomnography. Those with a left ventricular ejection fraction ≤45% and SDB (apnoea-hypopnoea index ≥15) are eligible. SDB is stratified into OSA with ≥50% of events obstructive or CSA with >50% of events central. Those with OSA must not have excessive daytime sleepiness (Epworth score of ≤10). Patients are then randomized to receive or not receive ASV. The primary outcome is the composite of all-cause mortality, cardiovascular hospital admissions, new-onset atrial fibrillation requiring anti-coagulation but not hospitalization, and delivery of an appropriate discharge from an implantable cardioverter-defibrillator not resulting in hospitalization during a maximum follow-up time of 5 years.

CONCLUSION: The ADVENT-HF trial will help to determine whether treating SDB by ASV in patients with HFrEF improves morbidity and mortality.

Original languageEnglish
Pages (from-to)579-587
Number of pages9
JournalEuropean Journal of Heart Failure
Volume19
Issue number4
DOIs
Publication statusPublished - Apr 2017

Keywords

  • Journal Article

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    Lyons, O. D., Floras, J. S., Logan, A. G., Beanlands, R., Cantolla, J. D., Fitzpatrick, M., Fleetham, J., John Kimoff, R., Leung, R. S. T., Lorenzi-Filho, G., Mayer, P., Mielniczuk, L., Morrison, D. L., Ryan, C. M., Series, F., Tomlinson, G. A., Woo, A., Arzt, M., Parthasarathy, S., ... ADVENT-HF Investigators (2017). Design of the effect of adaptive servo-ventilation on survival and cardiovascular hospital admissions in patients with heart failure and sleep apnoea: the ADVENT-HF trial. European Journal of Heart Failure, 19(4), 579-587. https://doi.org/10.1002/ejhf.790